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AGENCY CUSTOMER ID: RINCCON•01 <br />LOC#; <br />AC"R _._._.,..._....__....__ ------ <br />ADDITIONAL REMARKS SCHEDULE <br />PHILLIPSC <br />Page 1 of 1 <br />AGENCY LlCanse # 0US779S <br />Legends Environmental Ins, Services <br />NANTO INeUREn <br />Rincon Consultants, Inc. <br />210 N Ashwood Ave <br />POLICY NUMBER <br />Ventura, CA 90030 <br />EE PAGE 1 <br />'— <br />CARRIRRI NAIp CODE <br />EE PAGE 1 P 1 <br />.�........._..._„ <br />i ERrEpnvaonre:'EE P GE 1 <br />"- <br />,SEE <br />AnnITInMAI bCMAb VO <br />THIS ADDITIONAL REMARKS FORM ISA SCHEDULE TO ACORO FORM, <br />FORM NUMBER: -AGORO FGRMTITLE: Cartiflcato of LlahnittyneREince, <br />Geseription of GperationsfLocati0raNeh lal es: <br />Auto Liability and Workers Compensation as required by written contract, per Endoreoreent GG 24 0410 93, HA99180312 & <br />WC000313. Excess policy follows General Liability, Auto Liability and Employers Liability form. <br />i <br />s <br />i <br />i <br />ACOR❑ 101 (2008101) 'aJ 2005 ACORO —CORPORATION, All rights resnrvnrl <br />1 he ACORD name and logo are registered marks of ACORO <br />